Provider Demographics
NPI:1598713760
Name:HOGAN, KATHLEEN ANN (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN ANN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NOKOMIS WAY
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-6079
Mailing Address - Country:US
Mailing Address - Phone:781-453-5238
Mailing Address - Fax:
Practice Address - Street 1:148 CHESTNUT STREET
Practice Address - Street 2:BETH ISRAEL DEACONESS
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492
Practice Address - Country:US
Practice Address - Phone:781-453-5238
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74427207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease